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Nat Rev Microbiol. 2014 Jul;12(7):465-78. doi: 10.1038/nrmicro3270. Epub 2014 May 27.

Microbiological effects of sublethal levels of antibiotics.

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Department of Medical Biochemistry and Microbiology, BOX 582, Biomedical Center, Uppsala University, SE-75123 Uppsala, Sweden.


The widespread use of antibiotics results in the generation of antibiotic concentration gradients in humans, livestock and the environment. Thus, bacteria are frequently exposed to non-lethal (that is, subinhibitory) concentrations of drugs, and recent evidence suggests that this is likely to have an important role in the evolution of antibiotic resistance. In this Review, we discuss the ecology of antibiotics and the ability of subinhibitory concentrations to select for bacterial resistance. We also consider the effects of low-level drug exposure on bacterial physiology, including the generation of genetic and phenotypic variability, as well as the ability of antibiotics to function as signalling molecules. Together, these effects accelerate the emergence and spread of antibiotic-resistant bacteria among humans and animals.

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